where orders emerge

But Not Sufficiently Sacred for Physicians to Work for Free

How did it become normal, or for that matter even acceptable, to refer to medical patients as ‘consumers’? The relationship between patient and doctor used to be considered something special, almost sacred. Now politicians and supposed reformers talk about the act of receiving care as if it were no different from a commercial transaction, like buying a car.

Krugman here taps into the antediluvian hostility toward bourgeois modes of providing for one’s self and one’s family. This ancient prejudice holds that ‘mere’ commerce might be acceptable to govern the production and distribution of trifles such as candy and cars, but it’s too crass for goods and services that tradition or elites declare should be untainted by such sordid, competitive activities.

If consumer choice isn’t the ultimate driver of health-care supply, however, what – or who – will be its ultimate driver? Health-care suppliers? Congress? Government bureaucrats? Princeton dons?

Admittedly, the politically engineered wedge separating the receipt of health-care services from the responsibility for paying for these services creates problems. But the best way to address these problems is to remove the wedge rather than to arrogantly suggest that some mysterious transcendent force will more reliably look after individuals’ health-care needs than will those individuals themselves as they operate in markets in which insurers and physicians must compete for consumer dollars.